Transcript Addiction

Substance Use
Disorders
Substance Use Disorders

A maladaptive pattern of substance use
leading to clinically significant social,
emotional, or occupational impairment or
distress
Substance Dependence

Tolerance, as evidenced by either
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A need for more of the substance to achieve
intoxication or the desired effect
Diminished effect with continued use of the same
amount
Withdrawal, as evidenced by either
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Characteristic withdrawal symptoms for the
substance
The same or a different substance is taken to
relieve or avoid withdrawal symptoms
Substance Dependence
Must meet 3+ symptoms during a 12 month period
Tolerance
Withdrawal
Substance is taken in larger amounts or for longer periods
than intended
Persistent desire and unsuccessful efforts to cut down
A lot of time is spent getting, using or recovering from use
Important social, occupational or other activities are given
up because of use
Use is continued despite significant negative consequences
Robert Downey, Jr.

It’s like I’ve got a gun in my mouth,
and my hand on the trigger and I like
the taste of the gunmetal
Substance Abuse
Must meet one or more symptoms during a 1 year
period
Recurrent use resulting in a failure to meet major role
obligations at work, school, or home
Recurrent use in situations where it is physically hazardous
Recurrent substance-related legal problems
Continued use despite having persistent or recurrent social
or interpersonal problems
Causes
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Genetics (Marc Schuckitt)
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227 sons of alcoholics & 227 matched controls at
age 20
Administered alcohol
Sensitivity to alcohol assessed
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Subjective rating: How High are You?
Objective measure: Body Sway
Interviewed 10 years later re: symptoms of alcohol
dependence
Genetics
40%
% of men who met criteria
for alcohol abuse or
dependence
34%
% of men who met
criteria for alcohol abuse
or dependence
50%
30%
40%
20%
30%
13%
10%
43%
20%
11%
10%
0%
0%
Family History Family History
+ for
- for
Alcoholism
Alcoholism
20% with
the Lowest
Response
20% with
the Highest
Response
Causes
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Biological
 Areas associated with drug reward
 Ventral Tegmental Area (VTA) in the
brainstem
 Nucleus Accumbens (NA) in the midbrain
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VTA projects to the the NA
Causes
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Drugs of Abuse produce their rewarding
effects by increasing dopamine in the
Nucleus Accumbens, either by
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Stimulating the VTA to release dopamine onto
the cells of the NA
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Directly exciting the receptors in the NA
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Blocking reuptake of Dopamine in the NA
Causes
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Social Learning
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Vicarious Learning
 Learn about the consequences of a behavior by
observing a model engage in the behavior and
experience consequences
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Outcome Expectancies
 Learned association between a specific behavior
and a specific consequence OR
 Belief about the consequences of a behavior
Causes
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Positive Expectancies
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Belief that substance use will result in positive
outcomes  Increased or continued substance use
Negative Expectancies
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Belief that substance use will result in negative
outcomes  decreased or discontinued substance
use
Causes
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Operant Conditioning
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Behaviors that are followed by reinforcement are
repeated
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Initial substance use is reinforced by its effects
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High
Relaxation
Social disinhibition
Elevated mood
Causes
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Drugs are powerful reinforcers
 Role model uses drugs  gets high; less stressed  +
expectancy developed
 Opportunity arises  Use drug  get high; reduce
stress  + expectancies reinforced  repeat behavior
Causes
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Classical Conditioning
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Substance use becomes associated with internal
and environmental cues
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E.G., People, Places, Things, Thoughts, & Feelings
More frequent pairing results in a stronger
association
Exposure to these cues triggers thoughts about
using and craving
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Opiates, Alcohol, Nicotine  compensatory response
Cocaine  anticipatory response
Treatment
Medication
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Alcohol
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Disulfiram (antabuse)
Naltrexone
Acamprosate (campral)
Nicotine
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Nicotine Replacement
Bupropion
Medication
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Opiates
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Cocaine
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Methadone
Buprenorphine/Naloxone
No effective medications
Marijuana
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No effective medications
Behavioral
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Self-Help
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AA/NA
Rational Recovery
Contingency Management
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Offer rewards that compete with the reinforcing
effects of the drug
Behavioral
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Cognitive Behavioral Therapy
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Substance Use represents maladaptive coping
strategy
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Treatment involves
Identifying High Risk Situations
 Teaching skills for coping with those High Risk
Situations
 Differentiating Slips/Lapses from Relapses
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Cope
Don’t Use
Increase
Self-Efficacy
High
Risk
Situation
Don’t
Cope
Risk of
Relapse
Decreases
Risk of
Relapse
Increases
Pos.
Expectancies
of Use
triggered
Lapse
Or Slip
Abstinence
Violation
Effect